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Date(s): <br />2. <br />Address: <br />Phone: <br />3. <br />e e <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Califon <br />TEMP EVENT APP <br />END tS-02 <br />06/29/2023 <br />7. <br />8. <br />'-■•'3 i r 2C9 <br />Page 7 of ■ 1 <br />r <br />L-i <br />the festival coordinator three (3) weeks prior to this event <br />1. <br />• .aI; <br />_______________________ <br />>tect my unpackaged food and food-preparation areas from flies. <br />I am providing food that is NOT prepared at home: (K) Yes No <br />All food is prepared on-site or is from approved commercial facilities: g] Yes No <br />Name of facility: 6^ >77 7-^ , phone; { <br />Address of facility:\ C o I <br />I am providing a booth with the following: (to pro! <br />dust and the public) <br />areas fromXpuMc accep,able> and to separate food and food preparation <br /> Other (specify):_____________________ <br />NO,e: ± °n|y °PerHlions not required to provide enclosed booths are those which sell beveraaes from <br />pproved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />(3 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />[3 Other (specify): S <br />Electricity is provided for my booth’s use: [3 Yes No “ <br />' rXSXXTfb^Zmsyion^ure,hehotandm,dh0'din9ofpo,en,ia"y tortous <br />I 3135P'FOVldlng tl1e followin9 h0' temPerature control for the hot holding of all potentially hazardous foods above <br />O Camp stove Q Stemo & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />5 y vtl <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />™to a s®ned and “mPteted «W Of this checklist to <br />”* * ---------------------------—- • —- • •—• . - i <br />1. Name of Event: (tffa Date{s). <br />The following is information about my organization/business: <br />Name of organization/business: , C I <br /> <br /> <br />List food to be sold or given to the public: 1Z ^<Vt, ^Js, C -Pf,